BCOP Exam Graded A+

BCOP Exam Graded A+ JJ is a 57-year-old female who presented to the ED with 17 days of abdominal distention and 3 days of abdominal pain. Physical exam reveals a mass in her right lower abdomen. Lab results are notable for Hgb 7.1 g/dl and CA-125 of 212 U/mL. Ultrasound confirmed presence of a mass; additional imaging ruled out distant metastases. She is clinically staged with 1B, high grade serous ovarian cancer and underwent adequate surgical cytoreduction. Which of the following is the most appropriate management for JJ at this time? a) observation b) carboplatin/paclitaxel for 3 cycles c) carboplatin/paclitaxel for 6 cycles d) carboplatin/paclitaxel/bevacizumab for 6 cycles - Answer- c (high grade and serous) SM presents for a pelvic ultrasound that confirms a left adnexa mass 3 x 2.6 x 2.3 cm; subsequent biopsies confirm high-grade serous carcinoma. Additional staging confirms SM has clinical stage IVB (pleural effusions and liver lesions) ovarian cancer. Upon imaging and in consultation with surgery she is unlikely to be optimally cytoreduced. Which of the following is the most appropriate initial therapy for SM? a) Staging TAH/BSO -- adjuvant chemo b) IP/IV carbo/taxol -- debulking surgery c) Dose dense paclitaxel + carbo -- debulking surgery d) Carbo + gemcitabine + bevacizumab - Answer- c (SM has stage IVB ovarian cancer and was unfortunately deemed to be unlikely to attain optimal cytoreduction. Neoadjuvant chemotherapy followed by interval debulking surgery is most appropriate.) SM completed 3 cycles of neoadjuvant chemo, underwent debulking surgery attaining optimal cytoreduction and subsequently completed 3 more cycles of adjuvant chemo with paclitaxel, carboplatin and bevacizumab. Her response to therapy was a partial response. Following genetic testing, she was found to have a deleterious germline BRCA1 mutation. What maintenance strategy do you recommend? a) niraparib 300 mg once daily + bevacizumab 15 mg/kg every 3 weeks b) rucaparib 600 mg twice daily c) olaparib 300 mg twice daily + bevacizumab 15 mg/kg every 3 weeks d) PARP inhibitor maintenance not recommended following bevacizumab-based primary therapy - Answer- c (BRCA mutation, olaparib is the only PARP inhibitor approved in combo with bevacizumab) SM presents to clinic 3 months after completing adjuvant chemotherapy which was complicated by grade 2 peripheral neuropathy. She completed 3 months of maintenance olaparib and bevacizumab prior to developing worsening abdominal distention. A CT scan revealed lymphadenopathy and confirmed disease recurrence. Which of the following regimens is most appropriate for SM? a) carbo + gemcitabine b) gemcitabine c) niraparib + bevacizumab d) dostarlimab - Answer- b (SM experienced progression of disease 3 months following completion of initial platinum based adjuvant chemotherapy, indicating a platinum-resistant recurrence. Gemcitabine monotherapy is a category 2A, preferred therapy for platinum-resistant recurrence.) WW is a 56 year old male with metastatic colon cancer who is starting FOLFIRI (fluorouracil, oxaliplatin, leucovorin). On the first night of chemotherapy, he begins experiencing severe abdominal cramping and diarrhea. Which of the following treatments is most appropriate for WW at this time? a) loperamide b) atropine c) octreotide d) tincture of opium - Answer- b (Irinotecan may cause acute or delayed diarrhea. The immediate onset diarrhea is associated with cholinergic symptoms, and atropine is the drug of choice.) HT is a 54 year old male with metastatic colorectal cancer who is receiving cetuximab. Which of the following side effects should he be counseled on? a) QTc prolongation b) Hypomagnesemia c) Arterial thromboembolism d) Bleeding - Answer- b (Although not as common as other side effects, hypomagnesemia has been associated with cetuximab and panitumumab. Patient's electrolytes should be frequently monitored during the duration of EGFR inhibitor treatment and for approximately 8 weeks afterwards.) AL is a Caucasian 42 year old female who has a history of a gastric ulcer secondary to Helicobacter pylori infection. When questioned about her dietary habits, AL replies that she eats a burger and fries daily at the cafeteria and drinks 1-2 beers/week socially. In addition, her father was diagnosed with gastric cancer at age 51. Which of the following risk factors dose AL have for gastric cancer? a) Ethnicity, H. pylori infection, diet b) H. pylori infection, alcohol use, family history c) Ethnicity, H. pylori infection, alcohol use d) H. pylori infection, diet, family history - Answer- d (Risk factors for gastric cancer include H. pylori infection, smoking, a diet high in salted, fried or preserved foods and low in fruits and vegetables, positive family history, and heavy alcohol use.) A 30 year old female presents with bilateral adnexal masses, and is found to have stage IB, grade 3 ovarian cancer. She expresses her desire to have children in the future if possible. Which of the following treatments is most appropriate? a) Bilateral salpingo-oophorectomy (BSO), then observation b) BSO, then IV paclitaxel/carboplatin x 6 cycles c) BSO, then intraperitoneal (IP) paclitaxel/cisplatin x 6 cycles d) Total abdominal hysterectomy (TAH)/BSO, then IV and IP paclitaxel/cisplatin x 6 cycles - Answer- b (All ovarian cancer patients should receive comprehensive surgical staging, which differ based on fertility sparing vs. non-fertility sparing methods; For stage IA or IB disease, adjuvant IV taxane/carboplatin x 3-6 cycles is recommended for patients with grade 2 and 3 tumors; TAH does not preserve fertility) TS is a 36-year-old premenopausal white female who presents with a diagnosis of lobular carcinoma in situ (LCIS). She has a significant family history of breast cancer including her mother, maternal grandmother, and maternal aunt who were all diagnosed prior to 60 years of age. TS had one child at age 31 and no history of oral contraceptive use or estrogen replacement therapy. She was 12 years old at first menarche. What are TS's risk factors for the development of invasive ductal carcinoma? a) premenopausal status, family history, race and LCIS b) LCIS, family history, early age of menarche, age 30 at birth of first child c) family history, race, early age of menarche, age 30 at birth of first child d) premenopausal status, age, LCIS and 3 pregnancies - Answer- B (premenopausal status, race and number of pregnancies other than nulliparity are NOT risk factors) A decision was made to calculate TS's lifetime risk of breast cancer using the Claus model and the result was 20% lifetime risk. She declined to undergo genetic testing at this time. She was counseled that bilateral mastectomy +/- bilateral salpingo-oopherectomy is a recommended strategy for breast cancer risk reduction. Given that she is premenopausal, what is another appropriate risk reduction strategy according to NCCN Guidelines®? a) tamoxifen b) goserelin c) anastrozole d) raloxifene - Answer- A (20% lifetime risk and diagnosis of LCIS put her at high risk for development of breast cancer; risk reduction strategies include BSO or chemoprevention - tamoxifen for premenopausal or AI for postmenopausal) JH is a 39-year-old premenopausal Caucasian woman who presents to the clinic with a newly diagnosed left breast cancer found on screening mammogram. The breast mass measured 2.8 x 1.3 cm and her axillary lymph nodes were negative by ultrasound. Core biopsy of the breast mass indicates an invasive ductal carcinoma, nuclear grade 1 (well differentiated), ER = 80%, PR = 20%, HER2 IHC = 1+ (HER2-negative) JH has stage IIA disease (T2, N0, M0) that is ER-positive, PR-positive, HER2-negative and well differentiated. She has several good prognostic features (ER/PR-positive, HER2-negative, low grade). The goal of therapy for JH is cure. She plans to undergo primary surgery. If she were to have a lumpectomy, lymphatic mapping with SLNB would be the most appropriate option. Radiation therapy would be required with a lumpectomy. If this patient underwent a mastectomy, postmastectomy radiation would only be considered if she we - Answer- d (given her high RS, she is a candidate for chemo; tamoxifen is correct based on her premenopausal status) Following a course of chemotherapy, what would be the most appropriate adjuvant endocrine treatment for a postmenopausal patient with breast cancer? a) anastrozole x 5 years b) goserelin + anastrozole x 10 years c) tamoxifen x 10 years d) goserelin + tamoxifen x 5 years - Answer- a (AI + OAS is only recommended for premenopausal patients, OAS is never needed for postmenopausal patients) YC is a 37-year-old premenopausal African American woman who presents to her medical oncologist with a newly diagnosed right breast cancer confirmed with ultrasound and core needle biopsy as invasive ductal carcinoma. The tumor is 1.3 cm x 1.3 cm (T1c,N0,M0; stage 1A), ER negative, PR negative, HER2 IHC 2+, FISH = negative (triple negative). Pathology also reveals a nuclear grade of 2 (moderately differentiated) and a Ki-67 of 50%. She recently underwent a modified radical mastectomy with negative LN and negative margins (1 mm). She was found to have a BRCA2 mutation but otherwise has no other comorbidities. According to NCCN Guidelines®, which of the following adjuvant regimens would be the most appropriate for YC? a) Cyclophosphamide + methotrexate + fluorouracil (CMF) b) Carboplatin c) Dose dense doxorubicin + cyclophosphamide (AC) -- paclitaxel d) Paclitaxel - Answer- c (CMF is an non-preferred per NCCN)